Provider Demographics
NPI:1407543853
Name:SIDWELL, KATHERINE REEDER (FNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:REEDER
Last Name:SIDWELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5614 W TURNBUCKLE PL
Mailing Address - Street 2:
Mailing Address - City:MCCORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055-5516
Mailing Address - Country:US
Mailing Address - Phone:317-750-9231
Mailing Address - Fax:
Practice Address - Street 1:5614 W TURNBUCKLE PL
Practice Address - Street 2:
Practice Address - City:MCCORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46055-5516
Practice Address - Country:US
Practice Address - Phone:317-750-9231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28225693A163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care